Relationship Interests and Demographics Survey
1
What is your gender?
[______]
2
What is your age?
15-18
19-21
22-25
26-30
31-39
40+
3
What is your sexual orientation?
Heterosexual
Bi-sexual
Homosexual
4
Rank in order which of the following topics as they are interesting to
you? (with 12 being the higest score and 1 respectively, the lowest)
1 2 3 4 5 6 7 8 9 10 11 12
Science / Mathematics
Movies
Television
Technology
Literature
Food/Drink
Pets/Animals
Music
Art/Theater
Politics/Law
Sports
Religion/Philosophy
5
List some topics of interests that you think people of your opposite
gender would probably find important to them
Answer Option 1 ____________________________________________
Answer Option 2 ____________________________________________
Answer Option 3 ____________________________________________
Answer Option 4 ____________________________________________
Answer Option 5 ____________________________________________
6
List some topics of interests that people of your own gender find to be
important.
Answer Option 1 ____________________________________________
Answer Option 2 ____________________________________________
Answer Option 3 ____________________________________________
Answer Option 4 ____________________________________________
Answer Option 5 ____________________________________________
7
Rank in order of preference from 1-10 (with 1 being your least choice)
which of the following movie genres most interests you.
1 2 3 4 5 6 7 8 9 10 11
Comedy
Action
Fantasy/Science Fiction
Romance
Romanctic Comedy
Art
Drama
Indy
Foreign
Animation/pixar
Documentary
8
What current event or topic in the news most interests you right now?
____________________
9
What characteristic or attribute do you look for in a person of the
same gender that you would like to get to know better?
____________________
10
What characteristic or attribute do you look for in a person of the
OPPOSITE gender that you would like to get to know better?
____________________
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